Does Surgeon Subspecialty Training Affect Outcomes in the Treatment of Displaced Supracondylar Humerus Fractures in Children?

Autor:	Fisher BT; From the Department of Graduate Medical Education-Sanford Health (Dr. Fisher, Mr. Chong, Dr. Sauer, and Dr. Peterson), Fargo, ND, the University of North Dakota (Dr. Fisher, Mr. Chong, Mr. Flick, Ms. Forness, Dr. Sauer, and Dr. Peterson), School of Medicine & Health Sciences, Grand Forks, ND, the Sanford Sports Science Institute (Mr. Chong and Ms. Forness), Sanford Health, Fargo, ND, and the Sanford Orthopedics & Sports Medicine-Sanford Health (Dr. Sauer and Dr. Peterson), Fargo, ND., Chong ACM, Flick T, Forness M, Sauer BR, Peterson JB
Jazyk:	angličtina
Zdroj:	The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2021 May 01; Vol. 29 (9), pp. e447-e457.
DOI:	10.5435/JAAOS-D-20-00507
Abstrakt:	Introduction: The effect of the treating surgeon's subspecialty training on the outcomes of managing displaced supracondylar humerus fractures in the pediatric cohort remains under debate. The objective of this study was to examine patient outcomes and treatment variables for these injuries based on the surgeon subspecialty training. Methods: A retrospective study of children who had undergone primary closed reduction and percutaneous fixation for displaced supracondylar humerus fractures was done from January 2012 through May 2019. The following four groups with differing orthopaedic subspecialty training were evaluated: (1) pediatric fellowship trained (2) trauma fellowship trained, (3) sports medicine fellowship trained, and (4) all others. Outcomes examined included time to surgery, surgical time, fluoroscopy usage, postoperative follow-up protocols, radiographic measurements of alignment, and complications between surgeon groups. Results: Two hundred thirty-one cases were included (mean age 6 ± 2 years). Pediatric fellowship-trained surgeons took patients to surgery in a more delayed fashion (>12 hours, P = 0.02). Surgical time and fluoroscopy usage were significantly shorter for pediatric fellowship-trained surgeons (P < 0.001). No statistical difference was noted in pin configuration constructs between the groups. Pediatric fellowship-trained surgeons, on average, saw patients two times postoperatively within a year with most patients being within 30 days. Complications were not statistically different between the groups. Conclusions: Pediatric fellowship-trained orthopaedic surgeons provide more efficient care on a more delayed basis for displaced supracondylar humerus fractures than other subspecialty-trained orthopaedic surgeons. However, if barriers exist that limit the practicality or availability of these specialists, nonpediatric fellowship-trained surgeons achieve similar and satisfactory outcomes. Level of Evidence: Level III retrospective cohort study. (Copyright © 2021 by the American Academy of Orthopaedic Surgeons.)
Databáze:	MEDLINE
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